1. Field of the Invention
The present invention relates to a treatment apparatus for an endoscope, which is used in combination with the endoscope, and which is used in treatments such as resecting of a mucosa.
2. Description of the Related Art
There has heretofore been a strip biopsy using a grip forceps and a snare as a method of resecting an affected area in a mucosa in an endoscopic manner. One example of a method by the strip biopsy comprises: incising a part swollen in a bump shape; picking up or turning over the incised mucosa with the grip forceps introduced through a treatment instrument insertion passage (channel) of the endoscope so that a boundary tissue can be observed with the endoscope; and bringing a high-frequency or a high-energy incising instrument such as a laser scalpel introduced through the treatment instrument insertion passage of the endoscope onto the tissue and incising the tissue.
In this method, the range from which the mucosa is stripped with one stroke of the scalpel is limited to a part onto which the incising instrument abuts. The incision therefore has to be repeated many times in order to resect the mucosa in a broad range, and this is troublesome. Moreover, since smoke or steam is generated during the incising of the tissue of a mucosa lower layer, it is difficult to observe the part to be incised because of the smoke or steam. Additionally, to secure a field of view every incision, the smoke or steam has to be removed by an air supply and sucking operation of the endoscope, and the treatment time lengthens. Furthermore, to cut only the tissue of the mucosa lower layer in a narrow range of a boundary between a muscle layer and mucosa, it is necessary to carefully position/operate the tip end of the incising instrument under observation by the endoscope. For this, complicated operations such as coupled operations for bending the endoscope, elevating the forceps, and moving the incising instrument forwards and backwards have to be carried out, these operations are laborious and require cautiousness, and the operator has to sustain concentration for a long time. Moreover, since the mucosa is turned over, it is difficult to see the range of the mucosa lower layer to be cut. Therefore, it is necessary to return the mucosa to its original position and to confirm the affected area, and this is laborious and troublesome. To solve this, there is a method of incising the mucosa around the affected area. However, an operation for incising only the mucosa with the incising instruments with whose tip ends the mucosa can be incised, such as a needle-shaped high-frequency scalpel and laser scalpel, requires sophisticated skills and is as exhausting as the aforementioned incising of the boundary part.
Furthermore, known examples of the method of resecting the affected area in the mucosa in the endoscopic manner include a method comprising: injecting physiological saline into the mucosa lower layer of the affected area; expanding the mucosa in the bump shape and separating the mucosa from the muscle layer; sucking the mucosa via the tip end of a hood attached to the tip end of an endoscope inserting portion or the tip end of an over tube with which the inserting portion of the endoscope is covered; and squeezing the high-frequency snare attached beforehand to the tip end of the instrument to resect the mucosa (an endoscopic mucosal resection cap (EMRC) method or an endoscopic mucosal resection tube (EMRT) method).
In any of these methods, the resection range is limited, and a broad range of the affected area cannot be resected at once. Therefore, to resect a broad range of affected area, a partial resection needs to be repeated many times, and this requires a considerably long time and much labor and increases the burden or the patient and operator. Moreover, the range resected with the high-frequency snare has a substantially circular shape. Therefore, since the resection is carried out a plurality of times, a redundantly resected part is sometimes generated. When the region parts resected in this manner overlap, the operation is carried out so as to prevent the parts from being resected deeper than necessary. As a result, the resecting operation has been very difficult. Moreover, the resection range of the mucosa changes by the sucked amount of the mucosa in the EMRC or EMRT method, and it is difficult to keep the sucked amount constant. Therefore, an operation of continuously and evenly resecting the parts adjacent to each other has been difficult.
In Jpn. Pat. Appln. No. 11-64774 filed by the assignee of the present invention (Jpn. Pat. Appln. KOKAI Publication No. 2000-254146 (published as of Sep. 19, 2000)), to avoid the various problems, an endoscope treatment apparatus in which a high-frequency incising instrument is attached to the tip end of the hood, and a high-frequency treatment instrument of the apparatus are disclosed. In the apparatus described in Jpn. Pat. Appln. No. 11-64774, only a length corresponding to the diameter of the hood can be incised. Therefore, to incise a long part, partial incision needs to be carefully overlapped and repeated. Additionally, to incise only the mucosa, the sucking operation of the endoscope is finely adjusted, it is necessary to correctly and carefully control the height by which the mucosa is sucked up in the hood, and the operation is not easy.
Moreover, as shown in FIGS. 85 and 86, there have been proposed the endoscope treatment apparatus and high-frequency treatment instrument in which the high-frequency incising instrument is attached to a side aperture 67 disposed in a hood 2 or an over tube 41. In the apparatus shown in FIGS. 85 and 86, to incise only the mucosa, there has been required a laborious operation comprising: finely adjusting the sucking operation of an endoscope 10; accurately and carefully controlling the height by which the mucosa is sucked up into the hood 2; and operating the endoscope so as to prevent the mucosa from being resected more deeply than necessary by excessive suction.
The present invention has been developed noting the above-described circumstances, and objects thereof are as follows.
A first object is to provide a treatment apparatus for an endoscope in which a broad range of an affected area in a mucosa can be securely treated without leaving the affected area.
Another object is to provide a treatment apparatus for an endoscope in which only the mucosa can the securely treated without treating a part deeper than a mucosa lower layer.
A further object is to provide a treatment apparatus for an endoscope in which the broad range of the affected area in the mucosa can easily be treated in a short time.
To achieve the above-described objects, according to the present invention, there is provided a treatment apparatus for an endoscope, which is inserted into a body cavity together with a tip-end portion of the endoscope, and which treats a tissue in the body cavity. The treatment apparatus comprises: a base disposed in the vicinity of the tip-end portion of the endoscope; and an in-tissue inserting portion including a base end supported by the base, and a tip end which can be inserted into the tissue in the body cavity in a direction substantially parallel to the surface of the tissue, and extending to the tip end from the base end in a tapered shape. The in-tissue inserting portion has an inner side disposed in the vicinity of the surface of the tissue when inserted into the tissue. Furthermore, the treatment apparatus comprises: a high-frequency electrode for treating the tissue, which is supported by the base and disposed in the vicinity of the inner side of the in-tissue inserting portion; and a cable which supplies a high-frequency current to the high-frequency electrode from a high-frequency power supply apparatus disposed outside the body.
According to the treatment apparatus for the endoscope, for example, physiological saline is injected, a mucosa is separated from a muscle layer, and the in-tissue inserting portion is inserted under the mucosa via a small incised part incised using a high-frequency scalpel beforehand. When the high-frequency current is supplied to the high-frequency electrode for treating the tissue disposed in the vicinity of the inner side of the in-tissue inserting portion from the outside, only the necessary mucosa is incised. In this case, the in-tissue inserting portion protects parts other than the part to be incised from the influence of heat.
Moreover, according to the present invention, there is provided a treatment apparatus for an endoscope, comprising: a tubular member which is disposed in the vicinity of a tip-end portion of the endoscope, and includes a substantially cylindrical side wall; an aperture formed in the side wall; and an in-tissue inserting portion which is supported by the side wall of the tubular member and has a tip end projecting into the aperture and a tapered shape. The in-tissue inserting portion has an inner surface disposed in the vicinity of a surface side of a tissue when inserted into the tissue. The treatment apparatus further comprises: a high-frequency electrode for treating the tissue, which is disposed on an inner surface side of the in-tissue inserting portion; and a cable which supplies power to the high-frequency electrode from a high-frequency power supply apparatus disposed outside the body.
According to the treatment apparatus for the endoscope, a broad range of the affected area in the mucosa can be securely resected without leaving the affected area. Moreover, only the mucosa can securely be treated without treating a part deeper than the mucosa lower layer. Furthermore, the broad range of the affected area in the mucosa can easily be treated in a short time.
Furthermore, according to the present invention, there is provided a treatment apparatus for an endoscope, comprising: a tubular member which is disposed in the vicinity of a tip-end portion of the endoscope, and formed of an electrical insulator transparent and superior in heat resistance; and an in-tissue inserting portion which projects from the tubular member, and is formed of a material superior in heat resistance and electrical insulation. The in-tissue inserting portion has an inner surface disposed in the vicinity of a surface side of a tissue when inserted into the tissue. The treatment apparatus for the endoscope further comprises: a high-frequency incising instrument having an incising portion disposed at a predetermined distance from an inner surface of the in-tissue inserting portion; and a cable which supplies power to the incising portion of the high-frequency incising instrument from a high-frequency power supply apparatus disposed outside the body.
For the treatment apparatus for the endoscope, when the high-frequency incising instrument is disposed in a circumferential form, the mucosa of a lumen organ can be incised in a circular arc shape or an annular shape. When the instrument is disposed in an axial direction, not only the lumen organ but also the part of a forward/backward direction of the endoscope can be incised. Moreover, as the tubular member of the treatment apparatus, the hood whose tip end is obliquely cut to form an acute-angled edge can be used. In this case, the periphery of the affected area is incised beforehand using the high-frequency incising instrument, the edge of the instrument is inserted into the boundary between the mucosa and muscle layer, and the endoscope is moved forwards, so that the mucosa can be stripped. In this case, when the acute-angled edge is manufactured of a flexible material, only the relatively soft tissue of the boundary, having absorbed the physiological saline and become jellied, can be incised. Moreover, since the acute-angled edge is introduced into the body cavity through a guide tube, the mucosa is not damaged by the acute-angled edge during the inserting.
Therefore, according to the treatment apparatus for the endoscope, the periphery of the affected area of the mucosa can easily be incised in a short time. Moreover, the mucosa including the affected area can also easily be stripped in the short time. The time for performing the careful operation is short, the operator can therefore perform the treatment in a short time using less concentration than before, and both the operator and the patient have little fatigue. Moreover, since the method does not require skills as before, training does not require much time, and an apparatus and method usable by many operators can be obtained. Furthermore, for the incising before the stripping of the mucosa, after the positional relation between the incising instrument and mucosa is firmly grasped, the part of the mucosa to be incised can directly be observed with the endoscope while being incised, and the operator can incise the part with ease. During the mucosa stripping, the mucosa is physically stripped. This does not use high energy, and is therefore inexpensive as compared with an operation of incising and stripping the boundary with the high-frequency scalpel or a laser beam. Moreover, different from the high frequency or the laser, smoke or steam is not generated, the stripping can be continued without being interrupted, and the operator does not have to be irritated.
Furthermore, according to the present invention, there is provided a treatment apparatus for an endoscope, comprising: a tubular member which is disposed in the vicinity of a tip-end portion of the endoscope, and includes a substantially cylindrical side wall including an aperture; an in-tissue inserting portion having a tapered shape which projects toward the aperture; a deformable high-frequency electrode for treating a tissue, which is disposed at a predetermined distance from the in-tissue inserting portion inside the tubular member, and can abut the in-tissue inserting portion by an operation outside the body; and a cable which supplies a high-frequency current to the high-frequency electrode from a high-frequency power supply apparatus.
Additionally, according to the present invention, there is provided a treatment apparatus for an endoscope, comprising: a tubular member which is disposed in the vicinity of a tip-end portion of the endoscope, and includes a substantially cylindrical side wall; first and second apertures disposed in the side wall of the tubular member; first and second in-tissue inserting portions which are disposed in the tubular member, and have tapered shapes projecting toward the respective apertures; a first high-frequency electrode for treating a tissue, which is disposed on an inner surface side of the first in-tissue inserting portion, and extends in a plane substantially vertical to an axial direction of the tubular member; a second high-frequency electrode for treating the tissue, which is disposed on the inner surface side of the second in-tissue inserting portion, and extends substantially in the axial direction of the tubular member; and a cable which supplies the high-frequency current to the respective high-frequency electrodes.
Moreover, according to the present invention, there is provided a treatment apparatus for an endoscope, comprising: a base disposed in the vicinity of a tip-end portion of the endoscope; a first high-frequency electrode for treating a tissue, which is supported by the base, and extends in a first direction; a second high-frequency electrode for treating the tissue, which is supported by the base, and extends in a second direction different from the first direction; a high-frequency power supply apparatus disposed outside the body; first and second cables which are connected to the first and second high-frequency electrodes, and supply high-frequency currents to the first and second high-frequency electrodes from the high-frequency power supply apparatus; a switch apparatus which is disposed between the high-frequency power supply apparatus and the first and second cables, and selectively and electrically connects the high-frequency power supply apparatus to the first and second cables.
Additional objects and advantages of the invention will be set forth in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. The objects and advantages of the invention may be realized and obtained by means of the instrumentalities and combinations particularly pointed out hereinafter.